| NPI | 1518662352 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: KY 06156) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: KY 06156) |
| Enumeration Date | 2023-04-03 |
| Last Update Date | 2026-04-09 |